The Role of Negative-Pressure Wound Therapy in Latissimus Dorsi Flap Donor Site Seroma Prevention: A Cohort Study

BACKGROUND: Donor site seroma is the most common complication after latissimus dorsi (LD) flap harvest. This study aimed to evaluate the efficacy of negative-pressure wound therapy (NPWT) in preventing donor site seroma formation after the harvest of an LD flap for breast reconstruction. METHODS: In this prospective matched-pair study, 40 patients in whom an LD flap was harvested for breast reconstruction were enrolled. NPWT was used in 20 patients, and in a control group composed of another 20 patients, the conventional donor site dressing technique was used. Information was collected regarding postoperative complications, the incidence of seroma, total drainage volume, the number of percutaneous seroma aspirations, and the volume aspirated. RESULTS: In the NPWT group, the incidence of seroma formation after drain removal was significantly lower than in the control group (15% vs. 70%; odds ratio=0.07; relative risk, 0.24). Both the mean percutaneous aspirated volume (P=0.004) and the number of percutaneous aspirations (P=0.001) were also significantly lower in the NPWT group. There were no significant differences in the total drainage volume or the duration of wound drainage between the NPWT dressing group and the control group (P>0.05). CONCLUSIONS: This study showed that NPWT is a promising tool for reducing the incidence of seroma formation after removing the drain at the donor site after LD flap harvesting. It is a simple and safe technique.

Surgical Landmark of Optic Foramen: Evaluation by 3D-CT

Objective: The aim of this study was to determine the distance and direction of the optic foramen and inferior orbital rim at the reference point above infraorbital foramen. Materials and methods: Among the patients who had undergone CT scan by CT I-CAT, we evaluated the results of 150 orbits (75 male and 75 female). We measured distances and angles of optic foramen from inferior orbital rim by Simplant Master version 11 and Simplant CMF Module. Using the mean, standard deviation and 95% CI, all were analyzed by SPSS 11.5 for Window. Statistical differences were calculated between males and females using unpaired t-test. Results: The distances from optic foramen to inferior orbital rim above infraorbital foramen in males and females were 49.15+/-3.09 and 46.74+/-2.87 mm respectively (p=.000) and 95% CI were 48.44›49.87 and 46.08-47.40 mm respectively. The angle between the imaginary line drawing from optic foramen to that point on the inferior orbital rim and the saggital plane in males and females were 18.55+/-3.40 and 20.23+/-3.80 degree respectively (p=.005) and 95% CI were 17.76-19.33 and 17.37-18.97 degree respectively. Conclusion: In males, the optic foramen were located at 49.15+/-3.09 mm away from inferior orbital rim above infraorbital foramen and their directions were 18.55+/-3.40 degree medially to saggital plane. In females, the optic foramens were located at 46.74+/-2.87 mm away from inferior orbital rim above infraorbital foramen and their directions were 20.23+/-3.80 degree medially to saggital plane. From statistical data, l andmark of optic foramen were significantly difference in males and females.

Keloids

Keloids are the abnormal growth in healing process that produces the elevated and extended scar from the original wound. Although it is common in wound healing but its etiology is still unknown. Despite many previous studies about the etiology, pathophysiology and proper treatment of keloids, but they still are not clear. Many treatments including surgery, radiation, silicone sheet, cryosurgery, laser, pressure therapy and many medications have been used, but the success rates are only 70-80%. This article aims to review the etiology, pathophysiology, treatments and results of each treatment that has been used and under studies.